Future diets and the world's expanding waistlines

Where is the best place in the world to eat? It all depends, as new calculations from Oxfam show, on what you mean by "good". Food in the United States is cheap, abundant, varied and tasty, but it might not be all that good for you - too much fat and sugar have led to 36 percent of Americans being diabetic and 46 percent obese. Japan's food, by contrast, is much healthier, but it's extremely expensive and not as varied.

At the bottom end of the Oxfam table are countries like Chad and Angola, where food can be unaffordably expensive and not very nutritious. It can also be quite dull. In Madagascar (fourth from bottom) 79 percent of the food eaten comes from grains and starchy roots, with very little meat, fish, fruit or vegetables.

Perhaps the most interesting figures are not from the richest or poorest countries, but those in between - emerging economies making the transition to middle- or higher-income status. Some of the unhealthiest diets of all are in places like Fiji and Mexico, where more than 40 percent of adults are not merely overweight but obese.

The mechanism is no mystery. As people get richer, they want to eat more meat, fish and dairy products, more fried food, more sweets and cakes, washed down with fizzy drinks. Favourite foods vary from country to country, but the dietary transition is the same all over the world. Combined with moving to the cities, having less time to cook and leading less active lives, the dietary shift has brought expanding waistlines and an epidemic of ill-health. The number of overweight or obese people in the developing world tripled between 1980 and 2008.

Tim Lang, professor of food policy at City University London, has the sense of a world sleep-walking into disaster, despite plenty of evidence of what has been happening. “For years we have been churning out stunning demographic and epidemiological data documenting the problem,” he says. “It's almost like seeing, in slow motion, populations walking over a cliff, and us just watching it, counting them as they are going over and saying, 'Well, isn't this terrible?'.”

Reasons for concern

A paper recently published by Britain's Overseas Development Institute (ODI), Future Diets, sets out the reasons for concern. Besides health issues, it looks at how the food demands of a more prosperous world will be met, whether the supply of meat and dairy products can keep up with demand, and whether increased demand for cereals to feed livestock will put the prices of staple foods even further out of reach of the poorest.

The answers ODI found to these sustainability questions are reassuring. It should be possible to scale up production to meet demand and, surprisingly, demand could be met without the need for feed grains pushing up the price of cereals for human consumption.

But the health concerns remain. The report looked at five emerging economies - China, Egypt, India, Peru and Thailand - where a dietary transition has taken place, but it has been different in each country.

China has hugely increased its consumption of meat. In India, where many people are vegetarian, increasing prosperity has meant being able to afford more milk and dairy products. Thais have used their greater wealth to eat lots of fruit, Egyptians can satisfy their taste for fish, and Peruvians can afford more food in general, but still eat much the same range of foods they did before. So it is by no means inevitable that meat-rich, American-style diets will be adopted everywhere.

The report's author, Steve Wiggins, says, “What you see as you look across the world is that there are very great variations. In Latin America, especially Mexico, some parts of the Middle East and some Pacific Islands, we are seeing very high rates of overweight and obesity... Yet there are other parts of the middle-income world - especially in south and southeast Asia, and some parts of east Asia - where the incidence is running at about half the level… so there must be lessons to be learned from the countries of lower incidence.”

Taking action

For governments wanting to nudge their country's transition in a good direction, there are policy levers available. They can ban, ration or tax unhealthy foods, subsidize more nutritious ones, regulate manufacturers or try to educate the public.

“ The world trade agenda and agricultural strategies are not made by people concerned about health, but people concerned with making money. ”

Public education is the least controversial, but has not proven very effective. People in Europe and North America have had lots of public education, but still eat junk food. Barry Popkin, professor of nutrition at the University of North Carolina, cites South Korea as a country that ran a very effective information campaign until it had to open its economy.

“Every woman that got married was given two weeks of training in traditional diet, which focused on lots of vegetable dishes... They had signs all over: ‘Eat traditional food’. They were keeping out modern processes and retailing, and they had very low levels of overweight. But then the World Trade Organization (WTO) started opening up the country and that changed. And the diets are changing quite remarkably.”

Popkin says WTO regulations also tied the hands of countries like Samoa, which tried to stop unhealthy imports. “The Western Pacific countries tried to bar a number of products that were the leading causes of obesity, and they got hit by the World Trade Organization…. They were getting turkey tails and a bunch of other unhealthy products from the US that we would never touch, that were pure fat, and we stopped those countries, through the WTO, from banning their import.”

Food subsidies are expensive and rather out of fashion, but Norway tried them in the 1970s, subsidizing semi-skimmed milk production over full-cream milk, and the production of poultry over red meat. Consumer habits did change, but it is not clear how much was the effect of the subsidies.

A combination of regulation and heavy taxation has been used to reduce smoking, with some success, despite resistance from the tobacco industry, but efforts in the food sector have been more tentative. Mexico, which has woken up to the severity of its health problems, introduced a tax on sweetened drinks at the beginning of 2014.
Not so easy

Roxana Valdes-Ramos, of the Autonomous University of Mexico, welcomes the initiative but is not sure it will work. “We just don't know how it is going to affect the problem,” she says. “The Mexican population is very keen on, very used to drinking their fizzy beverages - they like it. I worry that the only thing that's going to happen is that they will just spend more on the same food.”

Tim Lang of City University London says the obesity epidemic is the result of many factors: not just poor diet, but also less exercise, a more urban lifestyle and changes in food retailing and production. “These are complex factors, complex drivers, complex inputs into shaping the food system. And that therefore requires complex levers. I don't see any simple intervention points,” he says.

“Even if one got a massive, massive tax, say a fat tax, if it was possible to do it. A sugar tax, possibly. I've always argued that an advertising tax is probably simpler to do. But you would need all of those to have an impact on the multiple levels that are driving this situation… And we have got to have changes in the built world to make it easier to take exercise, rather than build the world around cars. Well, that requires cities to be redesigned. That's a very big ask.”

Neville Rigby, the Convenor of the International Obesity Forum, told IRIN it would mean taking on powerful international business interests. “In practice, the range of food available is determined by a handful of large corporations. Decisions on what to eat are not just in the hands of individuals through consumer choice, not even in the hands of governments or the WHO [World Health Organization]. And the world trade agenda and agricultural strategies are not made by people concerned about health, but people concerned with making money.”